MEDICARE: COMMUNITY HEALTH CENTER OF SNOHOMISH COUNTY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	7034036	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073720108
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY HEALTH CENTER OF SNOHOMISH COUNTY

Provider Business Mailing Address
First Line	:	PO BOX 13060
Second Line	:
City	:	EVERETT
State	:	WA
Zip	:	98206-3060
Country	:	US
Telephone Number	:	425-789-3700
Fax Number	:	425-789-3754

Provider Business Practice Location Address
First Line	:	5929 EVERGREEN WAY
Second Line	:
City	:	EVERETT
State	:	WA
Zip	:	98203-6031
Country	:	US
Telephone Number	:	425-789-3700
Fax Number	:	425-789-3754

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	KENNETH M GREEN
Credential	:
Telephone Number	:	425-789-3700

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	06/13/2008

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Directions to “COMMUNITY HEALTH CENTER OF SNOHOMISH COUNTY ” Practice Location

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